Bipolar Meds

Question 1

Lithium Carbonate

ACTION

Answer 1

Chemical changes in the brain, including serotonin receptor blockade

Question 2

Lithium Carbonate

INDICATIONS

Answer 2

Episodes of acute mania
Prevents return of mania or depression
Decreases incidence of suicide

Question 3

Lithium Carbonate

ADVERSE EFFECTS

Answer 3

GI distress - take with meals or milk
Fine hand tremors - report increase in tremors
Polyuria, mild thirst - 2-3L of fluid/day
Weight gain
Renal toxicity - monitor I&O
Goiter & hypothyroidism with long term treatment
Bradydysrhythmias, hypotension, electrolyte imbalances - encourage fluid intake

Question 4

Lithium Carbonate

Less than 1.5 mEq/L

Answer 4

N/V/D
Thirst
Polyuria
Muscle weakness
Fine hand tremors
Slurred speech

Question 5

Lithium Carbonate

1.5-2.0 mEq/L

Answer 5

Mental confusion
Poor coordination
Coarse tremors
Ongoing GI distress

Question 6

Lithium Carbonate

2.0-2.5 mEq/L

Answer 6

Extreme polyuria of dilute urine
Tinnitus
Blurred vision
Ataxia
Seizures
Severe hypotension leading to coma
Respiratory complications leading to death

Question 7

Lithium Carbonate

Greater than 2.5 mEq/L

Answer 7

Rapid progression of manifestations leading to coma and death

Question 8

Lithium Carbonate

Toxicity nursing interventions

Answer 8

Hold medication
Excretion may need to be promoted
2-2.5: Mannitol or aminophylline may be prescribed
2.5<: Hemodialysis

Question 9

Lithium Carbonate

INTERACTIONS

Answer 9

Diuretics
NSAIDs
Anticholinergics

Question 10

Lithium Carbonate

ADMINISTRATION

Answer 10

Monitor levels Q2-3days until stable, then Q1-3mo.
Initial treatment of manic: 0.8-1.4 mEq/L
Maintenance level: 0.4-1.0 mEq/L
Effects begin in 7-14 days

Question 11

Mood Stabilizing AEDs

Answer 11

Valproic acid (Depakote)
Carbamazepine (Tegretol, Equetro)
Lamotrigine (Lamictal)
Topiramate (Topamax)

Question 12

Valproic acid (Depakote)
Carbamazepine (Tegretol, Equetro)
Lamotrigine (Lamictal)
Topiramate (Topamax)
INDICATION

Answer 12

Manic & depressive episodes
Prevents relapse of mania & depressive episodes
Particularly useful for mixed mania & rapid cycling

Question 13

Carbamazepine (Tegretol, Equetro)

ADVERSE EFFECTS

Answer 13

CNS effects
 - Nystagmus
 - Double vision
 - Vertigo
 - Staggering gait
 - Headache
Blood dyscrasias
Hypo-osmolarity
Skin disorders

Question 14

Lamotrigine (Lamictal)

ADVERSE EFFECTS

Answer 14

Double or blurred vision
Dizziness
Headache
N/V
Serious skin rashes

Question 15

Valproic acid (Depakote)
ADVERSE EFFECTS

Answer 15

GI effects
Hepatotoxicity: N/V, anorexia, fatigue jaundice
Pancreatitis
Thrombocytopenia
Teratogenesis

Question 16

Olanzapine (Zyprexa)
Quetiapine (Seroquel)
Aripiprazole (Abilify)
Ziprasidone (Geodon)

Answer 16

Atypical antipsychotics

Question 17

Olanzapine (Zyprexa)
Quetiapine (Seroquel)
Aripiprazole (Abilify)
Ziprasidone (Geodon)
Risperidone (Risperidal)
INDICATION

Answer 17

Relief of psychotic manifestations

Question 18

Olanzapine (Zyprexa)
Quetiapine (Seroquel)
Aripiprazole (Abilify)
Ziprasidone (Geodon)
Risperidone (Risperidal)
ADVERSE EFFECTS

Answer 18

New onset diabetes or loss of glucose control in diabetics
Weight gain
O.H.
Anticholinergic effects
Agitation, dizziness, sedation, sleep disruption
Mild EPS, such as tremor